Right-of-Entry Owner Consent and Release

OKLAHOMA ENERGY RESOURCES BOARD
Right-of-Entry Consent and Release
Project Name:
Project Number: Date:
The undersigned owner(s) (hereinafter "Owners") of certain property, being all of owner's right, title and interest in Sec. ,
T ,R , County, Oklahoma (the '"Property") hereby grant to the Oklahoma Energy Resources Board
('"OERB") and its agents, employees, and contractors, the right to enter upon said Property to evaluate, study, photograph and
explore and if deemed appropriate by the OERB, in its sole discretion, undertake remediation and restoration of historic oiVgas
production sites located on the Property (the "OERB Activities"). The OERB Activities are limited and qualified as set forth in
the OERB Landowner Information Sheet, attached hereto as Exhibit '"A" and incorporated herein by reference. Owners give thls
consent to enter upon the Property for the length of time necessary to complete any environmental evaluation, studies,
remediation and/or restoration undertaken by OERB on the Property, subject to Owners' continued use of the Property. If at
anytime the OERB determines that it is inappropriate to proceed, the OERB shall have the right to cease all activities on the
Property without ilotice 01 liability to Owners. This conseilt and release shall in no way be constiued as an act of conden~llation
or of trespass by OERB.
Owners hereby acknowledge, understand and agree that:
a) any and all OERB Activities are undertaken pursuant to speclfic statutory authority and neither the State of
Oklahoma nor OERB is liable for or accepts any liability for any past damages to, or pollution on, the Property irrespective of
the source of same;
b) Owners are not entitled to any compensation from the OERB or its agents, employees and contractors or the
State of Oklahoma;
c) neither the State of Oklahoma nor OERB is under any obligation to perform any environmental evaluation,
studies, remediation and/or restoration or any other activities or work on the Property.
Owners (check one) do /do not have knowledge of the existence of any other person or persons, company or
entity with responsibility for restoring the sites submitted to the OERB
Owners (check one) do /do not own the mineral rights, working or other interest to the Property.
Owners (check one) are /are not aware of any settlement, release or waiver of any claim for damages that have
been paid to Owner or to any prior owner with respect to the sites that have been submitted to the OERB.
Owners (check one) are /are not aware of any claim of litigation, past, contemplated or threatened, against any
party involving the Property.
Do Owners presently rent or lease the surface for agncultural, hunting, grazing or other purposes? Yes- No-
If yes, please specify rental or lease surface use: . Pmvide the surface lessee's name address and
telephone number (they will be sent OERB papeiwork also):
Is there active drilling, completion or production operations on the property? Y e s No-
If yes, provide the lease producer or operator's name, address and telephone number:
Indicate the approximate year you acquirsd this property:
Indicate the name of the person or entity you acquirsd the property from:
Page 1 of 2
V 1.1. Revised 6-27-12
Indicate how Owners acquired the property (did you inherit the property? If so -fill in the word " inheritance". If Owners
purchad property, the property was conveyed to Owners by a deed. If so, fill in the word '"deed").
This Right of Entry and Release is binding upon the Owners and Owners' heirs, successors in interest, assigns and transferes.
Owners agree to notify OERB in writing prior to any conveyance or transfer of the property or any interest in the Property,
including the granting of any surface, subsurface or mineral lease respecting the Property. In the event the Ownas fail to notify
OERB prior to a conveyance or transfer of the Property or any interest therein, Owners specifically agree to indemnify and hold
harmless OERB, its Board of Directors, members, representatives, employes, agents and contactors from any and all claims,
suits legal actiml or threats of claims, suits, or otlim legal action by any assign, successor or trarisferee of Owriers.
RELEASE: The undersignsd Owners, in consideration of the selection of the Property for environmental evaluation, studies,
possible remediation andlor restoration and possible other work by the OEM, do hereby release OEM and its Board of
Directors, itsmembers, representatives, agents, employees and contractors and the State of Oklahoma from any damages, claims,
suits or other actions which might arise as a result of any work whatsoever undertaken on the Property by, or on behalf of,
OERB, including without limitation any OERB Activities.
Witness the following signature(s) this day of ,20-.
(Landowner) (Witness)
(Landowner) (Witness)
(Landowner) (Witness)
(Landowner) (Witness)
(Landowner) (Witness)
(Landowner) (Witness)
e-mail address:
Mailing Address:
Telephone Number:
Page 2 of 2
V 1.1. Revised 6-27-12
EXHTBTT "A"
OERB LANDOWNER TNFORMATION SHEET
Your Property has been selected as a possible Project for restoration of certain historic well sites locatd on your Property. You
are advised that the following limitations and conditions apply to any and all activities and work of the OERB on your Property.
The OERB makes no representations as to the completion time for any Project selected. All activities arc subjoct
to the ava~labil~toyf budget4 funds and other resources, the OERB is not respons~blefo r any cutbacks or lack of
funding to the OERB or any other agency.
Any activities undertaken hy the OERB are limited to the scope of work approved hy the OERB for the Project
and the available funds budgeted by the OERB for the Project. Additional funds cannot be expended without
OERl3's pnor consent.
The OERB may erect a sign on the property during and suhsequent to the restoration activities on your
Property.
The OERB's restoration activities are limited to the restoration of surface issues associated with exploration and
production activities.
The OERB does not perform groundwater remediation.
Hazardous wastes. The OERB is under no obligation to remove and dispose hazardous wastes or materials
OERB determines, at any time to be present on the property. In the unlikely event hazardous wastes are identified
by OERB and the OEM elects to remove these wastes, the OERB will expect the landowner to fully cooperate in the
removal of these wastes. This may include the landowner signing any manifests would be requird to properly dispose
these wastes.
NORM. The OERB is under no obligation to remove and dispose naturally occurring radioactive materials
(NORM). In the event Naturally Occurring Radioact~veM aterial (NORM), which is a naturally occumng substance
that is sometimes associated with oil and gas production activities is encountered during the work on the Project, the
OERB will typically dispose NORM (including equipment, related scale or sludge) in accordance with those certain
NORM Management Guidelines developed in cooperation with the Oklahoma Corporation Commission. This may
include the onsite disposal of NORM.
The OERB under no obligation to provide topsoil or fill material from a source located off of Owner's property.
The OERB will utilize topsoil or fill material that is locatd on an Owner's property at no additional expense if the
topsoil or fill material is in pmximity to the Pmject AND is easily accessible for use Tf the Owner does not have such
sources in proximity or that are easily accessible, then the OERB will shape and mix the impacted area to blend with
the existing terrain to the extent possible as determind by the OERB.
Rocks and naturally occurring terrain. The OERB has no control over certain naturally occurring issues such as 1)
rock or exposed stone or rocks, stones or outcroppings that may surface during restoration activities; 2) inadequate or
insufficient soil profileslcharacteristics to support site re-vegetation; 3) a lack of readily available and easily accessible
fill material or topsoil on the Property; 4) existing erosion from any source whatsoever. The OERB shall have no
responsibility for any of the foregoing.
Public recards. All OERB and/or outside funded activities are a matter of public record and could result in such
activities being published in certain public databases (including but not limited to EPA Brownfields).
With reference to any of the apparent orphaned and abandoned equipment (improvements) located on your
property, hy signing this form you acknowledge that you have no claim or ownership to said equipment
(improvement) and that, to the hest of your knowledge, you are not aware of any other party that may claim
ownership to said apparent orphaned and abandoned equipment (improvements). If you are aware of any other
party that may claim ownership to said apparent orphaned and abandoned equipment (improvements), please notify the
OERB.
V 1.1 Revised 6-27-12

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OKLAHOMA ENERGY RESOURCES BOARD
Right-of-Entry Consent and Release
Project Name:
Project Number: Date:
The undersigned owner(s) (hereinafter "Owners") of certain property, being all of owner's right, title and interest in Sec. ,
T ,R , County, Oklahoma (the '"Property") hereby grant to the Oklahoma Energy Resources Board
('"OERB") and its agents, employees, and contractors, the right to enter upon said Property to evaluate, study, photograph and
explore and if deemed appropriate by the OERB, in its sole discretion, undertake remediation and restoration of historic oiVgas
production sites located on the Property (the "OERB Activities"). The OERB Activities are limited and qualified as set forth in
the OERB Landowner Information Sheet, attached hereto as Exhibit '"A" and incorporated herein by reference. Owners give thls
consent to enter upon the Property for the length of time necessary to complete any environmental evaluation, studies,
remediation and/or restoration undertaken by OERB on the Property, subject to Owners' continued use of the Property. If at
anytime the OERB determines that it is inappropriate to proceed, the OERB shall have the right to cease all activities on the
Property without ilotice 01 liability to Owners. This conseilt and release shall in no way be constiued as an act of conden~llation
or of trespass by OERB.
Owners hereby acknowledge, understand and agree that:
a) any and all OERB Activities are undertaken pursuant to speclfic statutory authority and neither the State of
Oklahoma nor OERB is liable for or accepts any liability for any past damages to, or pollution on, the Property irrespective of
the source of same;
b) Owners are not entitled to any compensation from the OERB or its agents, employees and contractors or the
State of Oklahoma;
c) neither the State of Oklahoma nor OERB is under any obligation to perform any environmental evaluation,
studies, remediation and/or restoration or any other activities or work on the Property.
Owners (check one) do /do not have knowledge of the existence of any other person or persons, company or
entity with responsibility for restoring the sites submitted to the OERB
Owners (check one) do /do not own the mineral rights, working or other interest to the Property.
Owners (check one) are /are not aware of any settlement, release or waiver of any claim for damages that have
been paid to Owner or to any prior owner with respect to the sites that have been submitted to the OERB.
Owners (check one) are /are not aware of any claim of litigation, past, contemplated or threatened, against any
party involving the Property.
Do Owners presently rent or lease the surface for agncultural, hunting, grazing or other purposes? Yes- No-
If yes, please specify rental or lease surface use: . Pmvide the surface lessee's name address and
telephone number (they will be sent OERB papeiwork also):
Is there active drilling, completion or production operations on the property? Y e s No-
If yes, provide the lease producer or operator's name, address and telephone number:
Indicate the approximate year you acquirsd this property:
Indicate the name of the person or entity you acquirsd the property from:
Page 1 of 2
V 1.1. Revised 6-27-12
Indicate how Owners acquired the property (did you inherit the property? If so -fill in the word " inheritance". If Owners
purchad property, the property was conveyed to Owners by a deed. If so, fill in the word '"deed").
This Right of Entry and Release is binding upon the Owners and Owners' heirs, successors in interest, assigns and transferes.
Owners agree to notify OERB in writing prior to any conveyance or transfer of the property or any interest in the Property,
including the granting of any surface, subsurface or mineral lease respecting the Property. In the event the Ownas fail to notify
OERB prior to a conveyance or transfer of the Property or any interest therein, Owners specifically agree to indemnify and hold
harmless OERB, its Board of Directors, members, representatives, employes, agents and contactors from any and all claims,
suits legal actiml or threats of claims, suits, or otlim legal action by any assign, successor or trarisferee of Owriers.
RELEASE: The undersignsd Owners, in consideration of the selection of the Property for environmental evaluation, studies,
possible remediation andlor restoration and possible other work by the OEM, do hereby release OEM and its Board of
Directors, itsmembers, representatives, agents, employees and contractors and the State of Oklahoma from any damages, claims,
suits or other actions which might arise as a result of any work whatsoever undertaken on the Property by, or on behalf of,
OERB, including without limitation any OERB Activities.
Witness the following signature(s) this day of ,20-.
(Landowner) (Witness)
(Landowner) (Witness)
(Landowner) (Witness)
(Landowner) (Witness)
(Landowner) (Witness)
(Landowner) (Witness)
e-mail address:
Mailing Address:
Telephone Number:
Page 2 of 2
V 1.1. Revised 6-27-12
EXHTBTT "A"
OERB LANDOWNER TNFORMATION SHEET
Your Property has been selected as a possible Project for restoration of certain historic well sites locatd on your Property. You
are advised that the following limitations and conditions apply to any and all activities and work of the OERB on your Property.
The OERB makes no representations as to the completion time for any Project selected. All activities arc subjoct
to the ava~labil~toyf budget4 funds and other resources, the OERB is not respons~blefo r any cutbacks or lack of
funding to the OERB or any other agency.
Any activities undertaken hy the OERB are limited to the scope of work approved hy the OERB for the Project
and the available funds budgeted by the OERB for the Project. Additional funds cannot be expended without
OERl3's pnor consent.
The OERB may erect a sign on the property during and suhsequent to the restoration activities on your
Property.
The OERB's restoration activities are limited to the restoration of surface issues associated with exploration and
production activities.
The OERB does not perform groundwater remediation.
Hazardous wastes. The OERB is under no obligation to remove and dispose hazardous wastes or materials
OERB determines, at any time to be present on the property. In the unlikely event hazardous wastes are identified
by OERB and the OEM elects to remove these wastes, the OERB will expect the landowner to fully cooperate in the
removal of these wastes. This may include the landowner signing any manifests would be requird to properly dispose
these wastes.
NORM. The OERB is under no obligation to remove and dispose naturally occurring radioactive materials
(NORM). In the event Naturally Occurring Radioact~veM aterial (NORM), which is a naturally occumng substance
that is sometimes associated with oil and gas production activities is encountered during the work on the Project, the
OERB will typically dispose NORM (including equipment, related scale or sludge) in accordance with those certain
NORM Management Guidelines developed in cooperation with the Oklahoma Corporation Commission. This may
include the onsite disposal of NORM.
The OERB under no obligation to provide topsoil or fill material from a source located off of Owner's property.
The OERB will utilize topsoil or fill material that is locatd on an Owner's property at no additional expense if the
topsoil or fill material is in pmximity to the Pmject AND is easily accessible for use Tf the Owner does not have such
sources in proximity or that are easily accessible, then the OERB will shape and mix the impacted area to blend with
the existing terrain to the extent possible as determind by the OERB.
Rocks and naturally occurring terrain. The OERB has no control over certain naturally occurring issues such as 1)
rock or exposed stone or rocks, stones or outcroppings that may surface during restoration activities; 2) inadequate or
insufficient soil profileslcharacteristics to support site re-vegetation; 3) a lack of readily available and easily accessible
fill material or topsoil on the Property; 4) existing erosion from any source whatsoever. The OERB shall have no
responsibility for any of the foregoing.
Public recards. All OERB and/or outside funded activities are a matter of public record and could result in such
activities being published in certain public databases (including but not limited to EPA Brownfields).
With reference to any of the apparent orphaned and abandoned equipment (improvements) located on your
property, hy signing this form you acknowledge that you have no claim or ownership to said equipment
(improvement) and that, to the hest of your knowledge, you are not aware of any other party that may claim
ownership to said apparent orphaned and abandoned equipment (improvements). If you are aware of any other
party that may claim ownership to said apparent orphaned and abandoned equipment (improvements), please notify the
OERB.
V 1.1 Revised 6-27-12